Clinical Analysis And Surgical Comparison Of Unilateral Multifocal Thyroid Cancer

Objective:With the increasing incidence of thyroid cancer,diagnostic techniques and treatment methods have continued to increase,the number of affected populations has increased,and people's emphasis on thyroid cancer has also gradually increased.The multifocal thyroid cancer(MPTC)means that there are more than one foci in the thyroid gland.According to the location of the tumor in the gland of MPTC,MPTC can be divided into unilateral MPTC and bilateral MPTC,in which bilateral MPTC is more than unilateral MPTC.There are differences in clinical factors and prognosis between multifocal carcinomas and single-focal carcinomas.However,there are controversies about the influence of different locations of multifocal diseases on the difference of clinical and pathological factors and whether the differences are statistically significant.Therefore,further study of this difference will help to better grasp the clinical pathological features of MPTC,especially unilateral MPTC,and guide the direction of the next treatment.MPTC is mainly treated by surgery.Over-Surgical removal of tissue can cause damage to the tissues and organs around the thyroid gland.Insufficient surgery can lead to recurrence.By studying the recurrence cases of thyroid cancer and studying the risk factors associated with postoperative recurrence,it will be possible to better guide future treatment,reduce the exposure of postoperative recurrence factors,and reduce the postoperative recurrence rate.In this paper,through the study of the feasibility of unilateral MPTC surgery and risk factors for postoperative recurrence,analysing the effect of different surgical methods on the unilateral MPTC after prognosis,to provide the basis.for the selection of unilateral MPTC surgery.Methods:The clinical and pathological features of unilateral MPTC and bilateral MPTC were compared.127 patients with unilateral MPTC were collected and divided into two groups according to different surgical method.The thyroidectomy group(bilateral gland plus isthmic resection)and one gland plus isthm ectomy group(unilateral gland plus isthmic resection).Central lymph node dissection was performed in both groups.Explore The differences between the two groups about surgery time,amount of blood loss,days of extubation,days of discharge from hospital,the rate of nerve injury,and rate of parathyroid injury.Analyze risk factors for recurrence or metastasis after surgery.Results:Compared with bilateral MPTC,unilateral MPTC showed a lower rate of lymph node metastasis(67.72% VS 70% VS),higher rate of Hashimoto's thyro iditis and invasive capsule rate(29.9% VS 26.3%,46.5% VS 44%).other clinic al pathological factors were not significantly specific.The operative time of th e unilateral MPTC excision group was longer than that of the partial excision group,and the difference was significant(P<0.05).There was no significant di fferences in the amount of blood loss,days of extubation days,days of discha rge from hospital,the rate of recurrent laryngeal nerve injury,and the rate of parathyroid injury(p>0.05).Univariate analysis showed thyroid capsular inva sion(OR=7.585,95%CI=0.886-64.9),tumor size ?2 cm(OR=5.833,95%CI=1.081-31.4)and surgical approach(OR=0.123).95%CI=0.014-1.05)was associatedwith recurrence after unilateral MPTC.Multivariate analysis showed thyroid c apsular invasion(OR=26.392,95%CI=2.373-344.254,P=0.006),surgical approac h(OR=0.041,95%CI=0.003-0.436,P=0.007)are related with unilateral MPTC recurrence.Conclusion:1.The difference of clinicopathologic characteristics between unilateral MPTC and bilateral MPTC mainly lies in that the unilateral MPTC has a lower rate of central lymph node metastasis,and the combined rate of Hashimoto's thyroiditis and the rate of invaginated capsule are higher than those of bilateral MPTC,but there were no statistically significant differences.2.All thyroidectomy with unilateral MPTC performed longer than one gland plus isthm ectomy group,and the difference between the two groups was significant.There was no difference in other factors,such as blood loss,number of extubation days,hospital stay and other factors..3.Analysis of the influencing factors of postoperative recurrence revealed that thyroid capsule encroachment,one thyroid gland plus isthmus ectomy was an independent risk factor for recurrence after unilateral MPTC.Therefore,unilateral MPTC for total thyroidectomy can reduce postoperative recurrence more effectively and reduce the damage to organ tissues caused by secondary surgery.Especially when the tumor is invasive,it is more necessary and important.